Acute viral nasopharyngitis medical therapy: Difference between revisions
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* '''Rhinovirus treatment (commom cold)''' | |||
:* '''Supportive therapy''' | |||
::* 1. Symptomatic treatment-[[Ipratropium bromide]] intranasal (2 sprays tid) {{and}} [[Clemastine]] 1.34 mg 1–2 tab PO bid–tid (over the counter) | |||
::* 2. Symptomatic relief by [[Ipratropium]] nasal spray decreases rhinorrhea and sneezing vs placebo.<ref name="pmid9880472">{{cite journal| author=Gern JE, Busse WW| title=Association of rhinovirus infections with asthma. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 1 | pages= 9-18 | pmid=9880472 | doi= | pmc=PMC88904 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9880472}}</ref> {{and}} [[Clemastine]] (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.<ref name="pmid8729205">{{cite journal| author=Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB| title=Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 4 | pages= 656-62 | pmid=8729205 | doi= | pmc= url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205 }}</ref>{{or}} Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).<ref name="pmid12802751">{{cite journal| author=Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA et al.| title=Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials. | journal=Clin Infect Dis | year= 2003 | volume= 36 | issue= 12 | pages= 1523-32 | pmid=12802751 | doi=10.1086/375069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802751 }} </ref> | |||
:::* Note (1): No antiviral treatment indicated.<ref name="pmid15693216">{{cite journal| author=Turner RB| title=New considerations in the treatment and prevention of rhinovirus infections. | journal=Pediatr Ann | year= 2005 | volume= 34 | issue= 1 | pages= 53-7 | pmid=15693216 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15693216 }} </ref> | |||
:::* Note (2): Found in half of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004).<ref name="pmid12517470">{{cite journal| author=Heikkinen T, Järvinen A| title=The common cold. | journal=Lancet | year= 2003 | volume= 361 | issue= 9351 | pages= 51-9 | pmid=12517470 | doi=10.1016/S0140-6736(03)12162-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517470 }} </ref> | |||
:::* Note (3): High rate of rhinovirus identified in children with significant lower resp tract infections.<ref name="pmid19258921">{{cite journal| author=Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T et al.| title=Rhinovirus associated with severe lower respiratory tract infections in children. | journal=Pediatr Infect Dis J | year= 2009 | volume= 28 | issue= 4 | pages= 337-9 | pmid=19258921 | doi=10.1097/INF.0b013e31818ffc1b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19258921 }} </ref> | |||
==References== | ==References== | ||
Revision as of 18:52, 12 August 2015
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Acute viral nasopharyngitis Microchapters |
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Differentiating acute viral nasopharyngitis from other diseases |
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Acute viral nasopharyngitis medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
As there is no medically proven and accepted medication directly targeting the causative agent, there is no cure for the common cold. Treatment is limited to symptomatic supportive options, maximizing the comfort of the patient, and limiting complications and harmful sequelae. The most reliable treatment is a combination of fluids and plenty of rest.
Medical Therapy
The common cold is self-limiting, and the host's immune system effectively deals with the infection. Within a few days, the body's humoral immune response begins producing specific antibodies that can prevent the virus from infecting cells. Additionally, as part of the cell-mediated immune response, leukocytes destroy the virus through phagocytosis and destroy infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the common cold resolves in seven days on average.
Palliative Care
The National Institute of Allergy and Infectious Diseases suggests getting plenty of rest, drinking fluids to maintain hydration, gargling with warm salt water, using cough drops, throat sprays, or over-the-counter pain or cold medicines. Saline nasal drops may help alleviate congestion.[1]
The American Lung Association recommends avoiding coffee, tea or cola drinks that contain caffeine and avoiding alcoholic beverages. Both caffeine and alcohol cause dehydration.
Antibiotics
Antibiotics do not have any beneficial effect against the common cold. Their use in cases of common cold infection is ineffective and may contribute to antibiotic resistance of bacteria present in the patient's body.
Antivirals
There are no approved antiviral drugs for the common cold.
ViroPharma and Schering-Plough are developing an antiviral drug, pleconaril, that targets picornaviruses, the viruses that cause the majority of common colds. Pleconaril has been shown to be effective in an oral form.[2][3] Schering-Plough is developing an intra-nasal formulation that may have fewer adverse effects.[4]
Over-the-counter Symptom Medicines
There are a number of effective treatments which, rather than treat the viral infection, focus on relieving the symptoms. For some people, colds are relatively minor inconveniences and they can go on with their daily activities with tolerable discomfort. This discomfort has to be weighed against the price and possible side effects of the remedies.
- analgesics such as aspirin or paracetamol (acetaminophen), as well as localised versions targeting the throat (often delivered in lozenge form)
- nasal decongestants such as pseudoephedrine or oxymetazoline which reduce the inflammation in the nasal passages by constricting local blood vessels
- cough suppressants such as dextromethorphan which suppress the cough reflex.
- first-generation anti-histamines such as brompheniramine, chlorpheniramine, diphenhydramine and clemastine (which reduce mucus gland secretion and thus combat blocked/runny noses but also may make the user drowsy). Second-generation anti-histamines do not have a useful effect on colds.
Other
Vitamin C
A well known supporter of the theory that Vitamin C megadosage prevented infection was Nobel Prize winner Linus Pauling,[5] who wrote the bestseller Vitamin C and the Common Cold.[6] A meta-analysis published in 2005 found that "the lack of effect of prophylactic vitamin C supplementation on the incidence of common cold in normal populations throws doubt on the utility of this wide practice".[7]
A follow-up meta-analysis supported these conclusions:
Prophylactic use "...of vitamin C has no effect on common cold incidence ... [but] reduces the duration and severity of common cold symptoms slightly, although the magnitude of the effect was so small its clinical usefulness is doubtful. Therapeutic trials of high doses of vitamin C ... starting after the onset of symptoms, showed no consistent effect on either duration or severity of symptoms. ... More therapeutic trials are necessary to settle the question, especially in children who have not entered these trials."[8][9]
Most of the studies showing little or no effect employ doses of ascorbate such as 100 mg to 500 mg per day, considered "small" by vitamin C advocates. Equally important, the plasma half life of high dose ascorbate above the baseline, controlled by renal resorption, is approximately 30 minutes,[10][11] which implies that most high dose studies have been methodologically defective and would be expected to show a minimum benefit. Clinical studies of divided dose supplementation, predicted on pharmacological grounds to be effective, have only rarely been reported in the literature.
Zinc Preparations
Zinc is an essential element, necessary for sustaining life. Recommended daily intake has been established and results of zinc deficiency and toxicity have been well characterized.
Zinc acetate and zinc gluconate have been tested as potential treatments for the common cold, in various dosage form including nasal sprays, nasal gels, and lozenges.[12][13] Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse.[14][15][16] Approximately half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action.[17] The studies differ in the salt used, concentration of the salt, dosage form, and formulation, and some suffer from defects in design or methods. For example, there is evidence that the potential efficacy of zinc gluconate lozenges may be affected by other food acids (citric acid, ascorbic acid and glycine) present in the lozenge.[18] Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.[19][20]
There are concerns regarding the safety of long-term use of cold preparations in an estimated 25 million persons who are haemochromatosis heterozygotes.[21] Use of high doses of zinc for more than two weeks may cause copper depletion, which leads to anemia.[22] Other adverse events of high doses of zinc include nausea, vomiting gastrointestinal discomfort, headache, drowsiness, unpleasant taste, taste distortion, abdominal cramping, and diarrhea.[17][22] Some users of nasal spray applicators containing zinc have reported temporary or permanent loss of sense of smell.[23]
Although widely available and advertised in the United States as dietary supplements or homeopathic treatments, the safety and efficacy of zinc preparations have not been evaluated or approved by the Food and Drug Administration. Authoritative sources consider the effect of zinc preparations on the cold unproven.
Steam Inhalation
Many people believe that steam inhalation reduces symptoms of the cold.[24]
However, a double-blind, placebo-controlled, randomized study found no effect of steam inhalation on cold symptoms.[25] A scientific review of medical literature concluded that "there is insufficient evidence to support the use of steam inhalation as a treatment."[26] There have been reports of children being badly burned when using steam inhalation to alleviate cold symptoms leading to the recommendation to "...start discouraging patients from using this form of home remedy, as there appears to be no significant benefit from steam inhalation."[27]
- Rhinovirus treatment (commom cold)
- Supportive therapy
- 1. Symptomatic treatment-Ipratropium bromide intranasal (2 sprays tid) AND Clemastine 1.34 mg 1–2 tab PO bid–tid (over the counter)
- 2. Symptomatic relief by Ipratropium nasal spray decreases rhinorrhea and sneezing vs placebo.[28] AND Clemastine (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.[29]OR Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).[30]
References
- ↑ "Common Cold". PDRHealth. Thomson Healthcare.
- ↑ Pevear, Daniel C. (1999). "Activity of Pleconaril against Enteroviruses". Antimicrobial Agents and Chemotherapy. 43 (9): 2109–2115. Unknown parameter
|coauthors=ignored (help); Unknown parameter|month=ignored (help) - ↑ McConnell, J. (2 October, 1999). "Enteroviruses succumb to new drug". The Lancet. 354 (9185): 1185. Check date values in:
|date=(help) - ↑ "Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295AM2)". ClinicalTrials.gov. U.S. National Institutes of Health. 2007. Unknown parameter
|month=ignored (help) - ↑ "Pauling L, The Significance of the Evidence about Ascorbic Acid and the Common Cold, Proc Natl Acad Sci U S A. 1971 November; 68(11): 2678–2681".
- ↑ Pauling, Linus (1970). Vitamin C and the common cold. San Francisco: W. H. Freeman. ISBN 0-7167-0159-6.
- ↑ Douglas RM, Hemilä H (2005). "Vitamin C for preventing and treating the common cold". PLoS Med. 2 (6). doi:10.1371/journal.pmed.0020168. PMID 15971944.
- ↑ Douglas R, Hemilä H, Chalker E, Treacy B (2007). "Vitamin C for preventing and treating the common cold". Cochrane Database of Systematic Reviews (Online) (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648.
- ↑ "Vitamin C 'does not stop colds'". BBC. 2007-07-18.
- ↑ "Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7".
- ↑ "Researchers Question Government Recommended Daily Allowance (RDA) for vitamin C, PR Web, July 7, 2004".
- ↑ Eby GA, Davis DR, Halcomb WW (1984). "Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study". Antimicrob Agents Chemother. 25 (1): 20–4. PMID 6367635.
- ↑ Macknin, ML (1999). "Zinc lozenges for the common cold". Cleve Clin J Med. 66 (1): 27–32. PMID 9926628. Unknown parameter
|month=ignored (help) - ↑ Jeffrey L. Jackson, Emil Lesho and Cecily Peterson (2000). "Zinc and the Common Cold: A Meta-Analysis Revisited". Journal of Nutrition. 130 (Supplement): 1512–15.
- ↑ Hulisz, D (2003). "Efficacy of zinc against common cold viruses: an overview". J Am Pharm Assoc. 44 (5): 594–603. PMID 15496046.
- ↑ Jackson JL, Peterson C, Lesho E (1997). "A meta-analysis of zinc salts lozenges and the common cold". Arch Intern Med. 157 (20): 2373–6. PMID 9361579.
- ↑ 17.0 17.1 "MedlinePlus Herbs and Supplements: Zinc".
- ↑ Eby GA (2004). "Zinc lozenges: cold cure or candy? Solution chemistry determinations". Biosci Rep. 24 (1): 23–39. PMID 15499830.
- ↑ Eby, George (2006). "Ineffectiveness of zinc gluconate nasal spray and zinc orotate lozenges in common-cold treatment: a double-blind, placebo-controlled clinical trial". Altern Ther Health Med. 12 (1): 34–38. PMID 16454145. Unknown parameter
|coauthors=ignored (help) - ↑ Darrell T. Hulisz. "Zinc and the Common Cold: What Pharmacists Need to Know".
- ↑ Barton JC, Bertoli LF (1997). "Zinc gluconate lozenges for treating the common cold". Ann Intern Med. 126 (9): 738–9. PMID 9139564.
- ↑ 22.0 22.1 "Zinc". PDRhealth. Thomson Healthcare.
- ↑ Sandra G. Boodman. "Paying Through the Nose: Maker of Cold Spray Settles Lawsuits for $12 Million but Denies Claim That Zinc Product Ruined Users' Sense of Smell". The Washington Post.
- ↑ Braun BL, Fowles JB, Solberg L, Kind E, Healey M, Anderson R (2000). "Patient beliefs about the characteristics, causes, and care of the common cold: an update". The Journal of Family Practice. 49 (2): 153–6. PMID 10718693.
- ↑ Forstall, G. J. (13 April, 1994). "Effect of inhaling heated vapor on symptoms of the common cold". Journal of the American Medical Association (JAMA). 271 (14). Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help) - ↑ Singh, M (19 April, 2004). "Heated, humidified air for the common cold". The Cochrane Database of Systematic Reviews (2). Check date values in:
|date=(help) - ↑ MA Akhavani (1 July, 2005). "Steam inhalation treatment for children". British Journal of General Practice. 55. Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help) - ↑ Gern JE, Busse WW (1999). "Association of rhinovirus infections with asthma". Clin Microbiol Rev. 12 (1): 9–18. PMC 88904. PMID 9880472.
- ↑ Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB (1996). "Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds". Clin Infect Dis. 22 (4): 656–62. PMC url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205 Check
|pmc=value (help). PMID 8729205. - ↑ Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA; et al. (2003). "Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials". Clin Infect Dis. 36 (12): 1523–32. doi:10.1086/375069. PMID 12802751.
- ↑ Turner RB (2005). "New considerations in the treatment and prevention of rhinovirus infections". Pediatr Ann. 34 (1): 53–7. PMID 15693216.
- ↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
- ↑ Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T; et al. (2009). "Rhinovirus associated with severe lower respiratory tract infections in children". Pediatr Infect Dis J. 28 (4): 337–9. doi:10.1097/INF.0b013e31818ffc1b. PMID 19258921.